Original Study
The Role of Surgery in Antenatal Ovarian Torsion: Retrospective Evaluation of 28 Cases and Review of the Literature

https://doi.org/10.1016/j.jpag.2021.08.007Get rights and content

Abstract

Study Objective

Antenatal ovarian torsion (AOT) is rare and requires differentiating from other congenital cystic masses of the abdomen and pelvis in neonates. In this study, it was aimed to evaluate the prenatal characteristics and postnatal outcomes of AOT.

Design, Setting, Participants, Interventions, and Main Outcome Measures

Hospital records of patients (n = 28) with diagnosis of AOT between 2004 and 2020 were reviewed and their prenatal characteristics, postnatal examination, imaging, operative, and histopathological findings were evaluated.

Results

There were 28 patients during the study period. In most of the patients (25/28; 89.3%) AOTs were detected prenatally. All were term babies with a mean birth weight of 3010 ± 466.6 g. Mean maternal age was 25.75 ± 3.65 years. Prenatal history was event-free in all and none had additional anomalies. Physical examination revealed mobile intra-abdominal cystic lesions in 16 (57.1%) patients. AOTs mimicked other pathologies as intestinal duplication cyst or mesenteric cyst (n = 7), complex ovarian cyst (n = 3), mature cystic teratoma (n = 3), simple renal cyst (n = 1), and ectopic kidney (n = 1) in 15 (53.6%) patients in postnatal ultrasonography. Elective laparoscopic surgery was performed in 26 (92.8%) patients. The other 2 patients required emergency open surgery because of acute symptoms. Ovaries were autoamputated in 17 (60.7%) patients. Histopathological examination revealed necrosis and dystrophic calcification in all specimens. There was neoplastic involvement in 2 patients (serous cystadenoma and gonadoblastoma). No complication occurred in the early follow-up period (mean: 73.9 ± 46.8 months).

Conclusion

AOTs can be detected easily during the antenatal period. Neoplastic involvement with AOTs is rare but possible. Although AOTs might mimic other cystic pathologies, it should be one of the first diagnoses to be considered, in the presence of a palpable intra-abdominal mass and complex cystic lesion in infant girls. It can be efficiently and safely managed using minimally invasive techniques.

Introduction

Ovarian cysts are the most common intra-abdominal masses found in female fetuses. Its incidence including milimetric follicles, is reported in 98% at the birth.1 Because of the surrounding hormonal environment at the antenatal period, cyst development is commonly seen in fetal ovary. Most of the simple fetal ovarian cysts regress spontaneously after birth. However, especially the large ones are less likely to resolve spontaneously, and might cause ovarian torsion in the intrauterine period.2

Ovarian torsion is the most common complication (25%-75%) of fetal ovarian cysts and often occurs in the antenatal period, rather than postnatally.1 Antenatal adnexal torsion might result in autoamputation because of of ischemia and infarction. It is a very rare complication, and its diagnosis and treatment have not been clearly defined. The characteristic feature of an autoamputated ovary is the presence of a free-floating mobile mass in the abdominal cavity. A wandering echogenic cyst without Doppler evidence of perfusion and the fallopian tube blind stump suggest autoamputation.3, 4, 5 We report herein on the management and follow-up data of 28 cases with antenatal ovarian torsion (AOT) and provide a review of the literature.

Section snippets

Materials and Methods

We reviewed hospital records of patients with a diagnosis of AOT (n = 28) between January 2004 and January 2020. We included patients younger than 1 year old at the time of surgery and who had an operative diagnosis of ovarian torsion. After institutional review board approval, clinical data, including gestational information, associated medical conditions, clinical manifestation, and the management and pathologic records were reviewed. All private health information for the patients was

Results

The mean gestational age of the patients was 38.5 ± 1.48 weeks and mean birth weight was 3010 ± 466.6 g. Maternal age had ranged from 20 to 33 years (mean, 25.75 ± 3.65 years). Twenty-five (89.3%) of 28 patients were diagnosed antenatally. The age of antenatal diagnosis ranged between 27 and 38 gestational weeks. Only in 4 patients’ antenatal ultrasound (US) findings were reported as AOT. Most of the patients (n = 11) had unspecified abdominal cystic mass shown in US examination; 7 patients

Discussion

Ovarian cysts are the most common intra-abdominal masses found in female fetuses. The first description of a fetal ovarian cyst was made by Doran in 1889. He reported bilateral ovarian cysts in a 7-month premature stillborn child. In 1898 Power reported the first infant to be successfully treated with surgery6 and Bulfamonte reported the first successfully treated newborn in 1942.7 The first large review was by Karrer and Swenson in 1961, and they presented 25 cases of ovarian cysts in

Conclusion

AOT, which is one of the first pathologies to be considered in female babies with abdominal cystic mass, requires careful follow-up because of the possible complications of intra-abdominal adhesions and the rare risk of ovarian neoplasia. They can be treated safely and effectively with minimally invasive methods.

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    • The authors indicate no conflicts of interest.

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    © 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.